not directly related to a person’s chronic illness (e.g., smoking and arthritis), adoption of healthy lifestyles by individuals with chronic illnesses can serve to “strengthen the host,” optimize overall health, and make them less vulnerable to further health threats and disability. Lifestyle behavior change cannot generally substitute for effective medical management of chronic illness, where it is available, but often supports “living well”—improving quality of life, ameliorating symptoms, and optimizing functional status. Below we summarize evidence related to benefits of preventive interventions for those with chronic illness as well as evidence-based strategies for optimizing adoption of the preventive intervention. For this overview we have relied primarily on systematic reviews and meta-analyses from such groups as the U.S. Preventive Services Task Force (USPSTF), Cochrane Database System Reviews, the Guide to Community Preventive Services of the Centers for Disease Control and Prevention (CDC), and the Advisory Committee on Immunization Practice (ACIP). In some cases, the research summarized in these reviews has emphasized the benefits of prevention for a particular chronic disease, but in general the body of research on living well with chronic disease is limited.

Lifestyle Behaviors

Physical Activity

Increasing physical activity has a number of benefits for those with chronic illnesses, including decreasing the risk of cardiovascular disease, some cancers, and diabetes, as well as improving physical functioning (Physical Activity Guidelines Advisory Committee, 2008). Physical activity interventions have been shown to benefit those with chronic illnesses as well as the general population. Whereas exercise can be expected to improve fitness in most individuals, for people with chronic illnesses, what is critical is determining the effects on quality of life, function, and progression of their illness. For example, a systematic review of physical activity trials in cancer survivors reports improvements related to fatigue, functional aspects of quality of life, anxiety, and self-esteem involving exercise (Speck et al., 2010). For type 2 diabetes patients, structured exercise programs, physical activity, and dietary advice from a physician potentially affect the disease course, reducing HbA1c levels (Umpierre et al., 2011). The American College of Sports Medicine and the American Diabetes Association have issued a joint position statement supporting participation in regular physical activity for individuals with type 2 diabetes (Colberg et al., 2010). Increasing physical activity through exercise also helps those with depression. A Cochrane review of 23 randomized controlled trials (RCT) showed that participants in exercise interventions showed greater reductions in depression



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